Healthcare Provider Details

I. General information

NPI: 1740729581
Provider Name (Legal Business Name): HEALTHY FOUNDATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 EAST WEST HWY STE 200
BETHESDA MD
20814
US

IV. Provider business mailing address

4350 E WEST HWY STE 200
BETHESDA MD
20814-4426
US

V. Phone/Fax

Practice location:
  • Phone: 301-970-4001
  • Fax: 301-970-4002
Mailing address:
  • Phone: 301-970-4001
  • Fax: 301-970-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: KURT KOCHES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 301-970-4011